Information Collection

Field FeasibilityTest Registration and Scheduling

IC 225817 under ICR 201702-0920-008 · OMB 0920-1176.

Documents and Forms

Document Name Document Type
Field FeasibilityTest Registration and Scheduling Form and Instruction
Registration Form Att 3a_Registration Form_170209.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Field FeasibilityTest Registration and Scheduling	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Registration Form	Att 3a_Registration Form_170209.docx		No		Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0167 Health Resources Utilization Statistics	FR Citation: 49 FR 37693

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	2,323	2,323

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.